Consultant denies allegations over professional performance

A CONSULTANT dermatologist failed to adequately treat a woman who was found to have a “significant skin cancer”, a Medical Council hearing has been told.

The patient found to have the carcinoma on her skin is one of 12 whose treatment by Dr Adam Jacobus Smith is the subject of a fitness-to-practise hearing taking place in Waterford.

The consultant denies a number of allegations regarding his professional performance.

All 12 patients involved were treated by Dr Smith, of the Whitfield Clinic in Waterford, between 2006 and 2009.

Evidence was heard yesterday from a woman in her 70s, referred to as “patient G”, and from a dermatologist who treated her after she was treated by Dr Smith in late 2007 and early 2008.

Dr Michelle Murphy told the hearing she was “concerned” about the woman’s case as a histology report showed she had “poorly differentiated squamous cell carcinoma” on her leg.

Dr Smith had not referred her to a plastic surgeon for a “wide excision” of the area of skin involved. This should have been done to decrease the chance of a local recurrence or metastasis (spreading of the condition to another part of the body).

Asked by Gabriel Gavigan SC, for Dr Smith, how she came to make a complaint to the Medical Council about Dr Smith, the witness said: “I had concerns that this patient’s significant skin cancer had not been adequately treated.”

The complaint was in the form of a letter from the Munster Dermatology Group.

After JP McDowell, solicitor for the council’s chief executive, objected to a line of questioning about the dermatology group, Mr Gavigan said: “Six doctors get together and make a complaint about a doctor practising in their area. I surely have the right to question their motivation for that.”

Dr Murphy said there was “collective concern that a number of patients appeared to have had sub-optimal treatment”.

In relation to a woman who had eczema, “patient H”, Dr Murphy said the symptoms included feeling as if there was something crawling under her skin.

Dr Smith diagnosed parasitophobia which “is not a phobia”, Dr Murphy said, but a “fixed delusion” where the patient actually believes there is something, such as insects, crawling under the skin, rather than just having a sensation like that.

The difference was not a subtle one, she said. “It’s a distinction a consultant dermatologist would have to make.”

Parasitophobia was a “very difficult condition to treat”, she said, and she believed such a diagnosis was incorrect in this case.

Dr Smith prescribed an anti-psychotic drug, Pimozide, but Dr Murphy said this should not have been done prior to carrying out a skin biopsy.

The hearing ran for three days in April, resumed yesterday and will continue today and tomorrow, with further private hearings in September in Dublin.